Sex Differences in Depression Treatment and Impact on Outcomes Following Premature Acute Coronary Syndrome

Aims: Access to anti-depressants, and prognosis in younger depressed men and women with acute coronary syndrome (ACS) requires further investigation. We assessed the prevalence of depression, antidepressant prescription, and the association of depression with major adverse cardiovascular events (MACE) in men and women with premature ACS. Methods and results: 1071 ACS men and women (≤ 55 years) were recruited between January 2009 and April 2013 into GENESIS PRAXY, a multicentre prospective observational cohort study, from 24 hospitals in Canada, one in the US and one in Switzerland. Depression was measured by self-report using the Diagnostic and Statistical Manual of Mental Disorders criteria. Prescription of antidepressants at baseline and 12 months, and MACE over 12 months, were assessed using medical chart review and self-report. Depression was present in 20% of men and 32% of women. Only 1% of men and women with no antidepressants at hospital admission were prescribed antidepressants at hospital discharge. Depressed men were 3 times less likely than depressed women to be prescribed antidepressants. The determinants of antidepressants at 12 months included the presence of cardiovascular risk factors in men, and the presence of depression in women. In sex-specific Cox regressions, depressed men had a 2.57 times greater risk of MACE compared with non-depressed men (95% CI: 1.53-4.32), which difference was not seen in women (HR=0.71, 95% CI=0.28-1.81). Conclusion: Despite a decade of sensitization, depression still needs to be better treated after ACS, especially in young men, given that depression is a potent risk factor for adverse outcomes.